Diabetic Ketoacidosis at Diabetes Onset: Still an All Too Common Threat in Youth

• Published in: The Journal of pediatrics Vol. 162; no. 2; pp. 330 - 334.e1
• Main Authors: Klingensmith, Georgeanna J., MD, Tamborlane, William V., MD, Wood, Jamie, MD, Haller, Michael J., MD, Silverstein, Janet, MD, Cengiz, Eda, MD, Shanmugham, Satya, BS, Kollman, Craig, PhD, Wong-Jacobson, Siew, MPH, Beck, Roy W., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2013
• Subjects: African Americans; autoantibodies; Child; children; Diabetes Mellitus, Type 1 - complications; Diabetic Ketoacidosis - epidemiology; Diabetic Ketoacidosis - etiology; education; Female; glycohemoglobin; health insurance; household income; Humans; Incidence; insulin-dependent diabetes mellitus; Male; multivariate analysis; Pediatrics; Prospective Studies; risk; youth; SES; Socioeconomic status; DAA; T1D; Diabetic ketoacidosis; Pediatric Diabetes Consortium; Diabetes-associated autoantibody; PDC; Body mass index; Hemoglobin A1c; Type 1 diabetes; DKA; HbA1c; BMI
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2012.06.058

Objective To define the demographic and clinical characteristics of children at the onset of type 1 diabetes (T1D), with particular attention to the frequency of diabetic ketoacidosis (DKA). Study design The Pediatric Diabetes Consortium enrolled children with new-onset T1D into a common database. For this report, eligible subjects were aged <19 years, had a pH or HCO3 value recorded at diagnosis, and were positive for at least one diabetes-associated autoantibody. Of the 1054 children enrolled, 805 met the inclusion criteria. A pH of <7.3 and/or HCO3 value of <15 mEq/L defined DKA. Data collected included height, weight, hemoglobin A1c, and demographic information (eg, race/ethnicity, health insurance status, parental education, family income). Results The 805 children had a mean age of 9.2 years, 50% were female; 63% were non-Hispanic Caucasian. Overall, 34% of the children presented in DKA, half with moderate or severe DKA (pH <7.2). The risk for DKA was estimated as 54% in children aged <3 years and 33% in those aged ≥3 years ( P = . 006). In multivariate analysis, younger age ( P = . 002), lack of private health insurance ( P < . 001), African-American race ( P = . 01), and no family history of T1D ( P = . 001) were independently predictive of DKA. The mean initial hemoglobin A1c was higher in the children with DKA compared with those without DKA (12.5% ± 1.9% vs 11.1% ± 2.4%; P < . 001). Conclusion The incidence of DKA in children at the onset of T1D remains high, with approximately one-third presenting with DKA and one-sixth with moderate or severe DKA. Increased awareness of T1D in the medical and lay communities is needed to decrease the incidence of this life-threatening complication.